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Yayın Brain-stem listeriosis: A comparison of SPECT and MRI findings(2006) Sahin S.; Arisoy A.S.; Topkaya A.E.; Karsidag S.Listeria monocytogenes, although uncommon as a cause of illness in the general population, can result in serious illness when it affects pregnant women, neonates, the elderly, and immunocompromised individuals. Typically, it is a food-borne organism. This report describes a case of brain-stem listeriosis in a previously healthy 51-year-old woman. The diagnosis was based on clinical findings, the results of cerebrospinal fluid (CSF) analysis, CSF culture, and magnetic resonance imaging (MRI) findings. MRI demonstrated upper brain stem and cerebellar peduncle involvement. In addition, Tc-99m exametazime (HMPAO)-labeled single photon emission computed tomography (SPECT) of the brain revealed bilateral cerebellar hypoperfusion. Antibiotic therapy resulted in partial clinical recovery after 3 weeks. At the end of 6 months, brainstem findings had nearly resolved. However, although minimal residual findings were observed on MRI at 6 months, bilateral diffuse cerebellar hypoperfusion remained on Tc-99m HMPAO brain SPECT. ©2006 Medscape.Yayın Cholecystitis related to Brucella melitensis: A rare presentation(2008) Gunal E.K.; Topkaya A.E.; Arisoy A.; Aydiner O.; Gökçen G.; Aksungar F.B.; Karabulut M.; Tulbek M.Y.; Aytug O.N.Although human brucellosis is a multisystemic disease, cholecystitis due to Brucella species is a rare manifestation. Here we present a 64-year-old woman with Brucella cholecystitis who was admitted to the hospital with fever and arthralgias for the last 10 days. Her complete blood count and blood chemistry were unremarkable other than C-reactive protein: 3.08 mg/dL (<0.5 mg/dL), aspartate transaminase: 70 U/L (<65 U/L), alanine transaminase: 71 U/L (<37 U/L), ?-glutamyl transferase: 748 U/L (<85 U/L), and alkaline phosphatase: 285 U/L (<136 U/L). On the second day of hospitalization, she complained of diffuse abdominal pain, and physical examination revealed Murphy sign. Abdominal ultrasonography was consistent with acute cholecystitis. She was given ciprofloxacin because she refused cholecystectomy. On the 10th day of admission, she still had fevers, and Brucella melitensis was recovered from blood culture specimens. Brucella agglutination tests were also found to be positive. She was symptom free after the fifth day of introduction of streptomycin, doxycycline, and rifampicin. © 2008 Lippincott Williams & Wilkins, Inc.Yayın A frequently overlooked bacteria in clinical microbiology laboratories: Arcanobacterium haemolyticum [Klinik mikrobiyoloji laboratuvarinda siklikla atlanan bir etken: Arcanobacterium haemolyticum](2011) Balikci A.; Topkaya A.E.; Belaş Z.Arcanobacterium haemolyticum, previously known as Corynebacterium haemolyticum, is a facultative anaerobic, gram-positive bacillus with negative catalase and positive CAMP inhibition test results. It may be the causative agent of about 0.5-3% of acute bacterial pharyngitis especially in children and young adults. Since growth of A.haemolyticum is usually inhibited by flora members and since it slowly develops hemolysis in sheep blood agar and its colony morphology resembles beta-he-molytic streptococci, it is frequently overlooked in the evaluation of throat cultures. The aims of this study were to investigate the isolation frequency of A.haemolyticum from the throat cultures of pediatric patients by using both sheep and human blood agar media, and to evaluate the performances of those media for the identification of A.haemolyticum. A total of 355 patients (median age: 7 years) who were admitted to pediatric outpatient clinics with the symptoms of tonsillopharyngitis between March-July 2010 period, were included in the study. Swab samples obtained from tonsils and posterior oropharynx were inoculated into a divided plate which contained 5% sheep blood agar in one half and 5% human blood agar in the other half. After incubation in 5% CO 2 at 37°C, the beta-hemolytic colonies with a microscopic morphology of gram-positive bacilli were further evaluated on 24, 48 and 72 th hours. Identification of A.haemolyticum was based on negative catalase test, positive reverse CAMP test and biochemical characteristics obtained by API-Coryne (bioMérieux, France) identification system. In our study, beta-hemolytic colonies were detected in the throat cultures of 56 (16%) patients, of which 14% (49/355) were identified as beta-hemolytic streptococci (46 group A, 2 group G, 1 group C), and 2% (7/355) were identified as A.haemolyticum. All of the A.haemolyticum isolates were characterized by the production of beta-hemolysis in human blood agar at 24 hours, while the beta-hemolysis generation time in sheep blood agar was 48 hours for four isolates and 72 hours for three isolates. A.haemolyticum was identified in 2% of children with tonsillopharyngitis during the five months study period in spring/summer. All of the strains were isolated at human blood agar in 24 hours. Thus, in order to isolate A.haemolyticum in routine throat cultures, sheep blood agar plates together with human blood agar plates should be used in clinical microbiology laboratories.Yayın Is there any relationship between streptococcal infection and multiple sclerosis?(2007) Topkaya A.E.; Sahin S.; Aksungar F.B.; Boru U.T.; Yildiz Z.; Sur H.Background: Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of uncertain etiology. Although the mechanisms of inducting autoimmunity by some of the infectious agents have been investigated, there is not yet enough research on streptococcal infections. Material/Methods: To understand the effect of past group A streptococcal infection on MS, antistreptolysin O (ASO) and antideoxyribonuclease B (ADNase B) were measured in 21 patients with relapsing-remitting MS and 21 healthy blood donors by nephelometric assay. Results: ADNase B levels in the patients with MS were found to be significantly higher than in the controls (p<0.001); however, ASO levels were similar in both groups. Conclusions: These findings indicate that a relationship between multiple sclerosis and streptococcal infections may exist, but to acquire a better understanding of the role of group A streptococci in the pathogenesis of multiple sclerosis, more studies with animal models are necessary. © Med Sci Monit, 2007.Yayın Isolation ratio and T-serotyping of group A streptococci from pediatric upper respiratory tract infections in Turkey(2005) Topkaya A.E.; Yildirim T.; Arsan S.Objective: Acute rheumatic fever can follow throat infections with group A streptococci. Certain serotypes of group A streptococci such as M1, M3, M5, M6, M14, M18, M19, M24 are associated with this disorder. Immunity to streptococci and to rheumatic fever depends on antibodies to the M proteins. Due to current scarcity of M-typing sera, many laboratories use T typing and opacity factor production for serotype identification of group A streptococci. In order to, investigate the most common serotypes of group A streptococci in our country in recent years we studied T-agglutination typing and opacity factor of 120 group A streptococci strains isolated from throat cultures of 930 children. Methods: Diffuse, stable suspensions of group A streptococci were tested with polyvalent antisera (T,U,W,X,Y) by slide agglutination. Microplate method was used for opacity factor detection. Results: T-protein -agglutination patterns U (2,4,6,28) were the most common among typeable strains. The rate of T-protein -agglutination patterns T (1,3,13, B3264) and X (8,14,25,lmp.19) were 20% and 18% respectively. Opacity factor production rate of isolated group A streptococci strains was 65%. Conclusion: To profit global assessment of rheumatic fever and rheumatic heart disease, more epidemiologic and serotyping research is required in our country.Yayın Serotypes and antimicrobial susceptibilities of invasive group a streptococci identified in Eastern Black Sea Region of Turkey [Türkiye'nin dogu karadeniz bölgesinden tanimlanmiş invazif a grubu streptokoklarin serotipleri ve antimikrobiyal duyarliliklari](2011) Bayramoglu C.; Topkaya A.E.; Balikci A.; Aydin F.Frequency of invasive group A streptococcus (GAS) infections is increasing worldwide in recent 20 years. Serotypes responsible for these clinical manifestations and their antibiotic susceptibilities should be known in order to establish preventive measures and initiate appropriate treatment. This study was aimed to determine the serotypes, antibiotic susceptibilities and inducible clindamycin resistance among invasive GAS isolated between 2006-2009 period. A total of 22 GAS strains isolated from clinical samples [sterile body fluids (peritoneal, pleural, pericardial, joint and cerebrospinal fluids), blood, tissue biopsy] of the patients (14 male, 8 female; age range: 3-82 years, median age: 59) who admitted to Karadeniz Technical University Faculty of Medicine, Farabi Hospital located in Trabzon province (Eastern Black Sea Region of Turkey), between March 2006 and March 2009 were included in the study. GAS serotypes were determined by the investigation of serum opacity factors (SOF), T proteins and M proteins. SOF production was investigated by microplate method using human serum and SOF types were determined by SOF-inhibition test using specific antisera. T protein types were detected by agglutination method using polyvalent anti-T sera, and M serotypes were detected by capillary precipitation method using M antisera. Antimicrobial susceptibility tests were performed by disk-diffusion method according to CLSI recommendations. SOF were positive in 9 (41%) samples. Use of T antiserum yielded T (n= 8) and U (n= 7) types and M antiserum M1 (n= 4) and M2 (n= 3) types. The overall antibiotic susceptibility rate of the isolates was 68% (15/22) and overall resistance rate was 32% (7/22). All of the GAS strains were found susceptible to benzylpenicillin, ceftriaxone, vancomycin, levofloxacine and linezolid, however 9 (41 %) were intermediate susceptible to tetracycline and 1 (4.5%) was intermediate susceptible to erythromycin. Four (18%) strains were found resistant to tetracycline, while three strains (13.5%) were found resistant to chloramphenicol. Inducible clindamycin resistance was found positive only in one strain. The serotypes determined in this study indicated that 33% of our invasive serotypes were covered by the hexavalent vaccine and 62% by the 26-valent vaccine. Multi-center surveillance studies are required to determine the serotype distribution of invasive GAS in Turkey and to provide valuable information for the development of appropriate vaccines in our country.
